A 5-year old got infected by her pet cat
A 5-year-old girl came to the emergency department with complaints of a mass in front of her left ear (preauricular mass) and submandibular adenopathy on the left side of her face for the past 2 months. The patient gave no history of fever or any other associated symptoms. She had no visual complaints. The girl had a pet cat with which she played frequently.
Physical Examination:
On examination, there was an excoriation below the left eye (Panel A, red arrow), a preauricular mass which was tender and fluctuant on palpation (Panel A, blue arrow, and Panel B), and submandibular adenopathy (Panel A, black arrow).
Diagnosis:
A purulent, brownish fluid was aspirated from the preauricular mass, which was sent for culture. With the given history and clinical manifestations, a working diagnosis of cat scratch disease was made. The patient was treated on an outpatient basis with a prescription of oral azithromycin for 5 days.
The aspirate showed the following results:
- Negative culture of the aspirate in chocolate agar.
- An inflammatory infiltrate with necrosis was noticed on the histopathological analysis.
- Warthin–Starry staining detected bacilli.
Bartonella henselae (IgM titer, >1:1024; IgG titer, >1:20), gram-negative bacilli, were detected on the serology.
On the 2-month followup, the preauricular mass and submandibular adenopathy had subsided.
Parinaud’s Oculoglandular Syndrome
Parinaud’s oculoglandular syndrome is a manifestation of cat scratch disease. Cat-scratch disease is the most common cause of Parinaud’s oculoglandular syndrome. It is characterized by unilateral granulomatous conjunctivitis, preauricular lymphadenitis on the same side. The disease is spread by the hand-to-eye contact with an incubation period of 3 days to 3 weeks. It is associated with a scratch, bite of the cat, or touching the eye with a hand that has been in contact with an infected cat’s fluids/saliva.
Usually, the infected patient is diagnosed on clinical grounds with positive contact history. But the tests may be required for confirming the diagnosis.
Since the disease is self-limited when mild, so the infected patient is usually provided supportive treatment in mild cases. Whereas, in severe cases, systemic antibiotics may be considered.
References
Catalina Arango-Ferreira, M. a. (2018, November 01). Parinaud’s Oculoglandular Syndrome in Cat Scratch Disease. Retrieved from The New England Journal of Medicine: https://www.nejm.org/doi/full/10.1056/NEJMicm1804942
